Novel virtual nasal endoscopy system based on computed tomography scans

Background Currently,many simulator systems for medical procedures are under development.These systems can provide new solutions for training,planning,and testing medical practices,improve performance,and optimize the time of the exams.However,to achieve the best results,certain premises must be followed and applied to the model under development,such as usability,control,graphics realism,and interactive and dynamic gami-fication.Methods This study presents a system for simulating a medical examination procedure in the nasal cavity for training and research purposes,using a patient′s accurate computed tomography(CT)as a reference.The pathologies that are used as a guide for the development of the system are highlighted.Furthermore,an overview of current studies covering bench medical mannequins,3D printing,animals,hardware,software,and software that use hardware to boost user interaction,is given.Finally,a comparison with similar state-of-the-art studies is made.Results The main result of this work is interactive gamification techniques to propose an experience of simulation of an immersive exam by identifying pathologies present in the nasal cavity such as hypertrophy of turbinates,septal deviation adenoid hypertrophy,nasal polyposis,and tumor.

Comparison of 3 mm versus 4 mm rigid endoscope in diagnostic nasal endoscopy

Objective:Compare nasal endoscopy with 3 mm versus conventional 4 mm rigid 30° endoscopes for visualization,patient comfort,and examiner ease.Methods:Ten adults with no previous sinus surgery underwent bilateral nasal endoscopy with both 4 mm and 3 mm endoscopes (resulting in 20 paired nasal endoscopies).Visualization,patient discomfort and examiner’s difficulty were assessed with every endoscopy.Sino-nasal structures were checked on a list if visualized satisfactorily.Patients rated discomfort on a standardized numerical pain scale (0-10).Examiners rated difficulty of examination on a scale of 1-5 (1 =easiest).Results:Visualization with 3 mm endoscope was superior for the sphenoid ostium (P =0.002),superior turbinate (P =0.007),spheno-ethmoid recess (P =0.006),uncinate process (P =0.002),cribdform area (P =0.007),and Valve of Hasner (P =0.002).Patient discomfort was not significantly different for 3 mm vs.4 mm endoscopes but correlated with the examiners’ assessment of difficulty (r =0.73).The examiner rated endoscopy with 4 mm endoscopes more difficult (P =0.027).Conclusions:The 3 mm endoscope was superior in visualizing the sphenoid ostium,superior turbinate,spheno-ethmoid recess,uncinate process,cribriform plate,and valve of Hasner.It therefore may be useful in assessment of spheno-ethmoid recess,nasolacrimal duct,and cribriform area pathologies.Overall,patients tolerated nasal endoscopy well.Though patient discomfort was not significantly different between the endoscopes,most discomfort with 3 mm endoscopes was noted while examining structures difficult to visualize with the 4 mm endoscope.Patients’ discomfort correlated with the examiner’s assessment of difficulty.

Transnasal endoscopic retrograde chalangiopancreatography using an ultrathin endoscope: A prospective comparison with a routine oral procedure

AIM: To investigate if transnasal endoscopic retrograde cholangiopancreatography (n-ERCP) using an ultrathin forward-viewing scope may overcome the disadvantages of conventional oral ERCP (o-ERCP) related to the large- caliber side-viewing duodenoscope. METHODS: The study involved 50 patients in whom 25 cases each were assigned to the o-ERCP and n-ERCP groups. We compared the requirements of esophagogastroduodenoscopy (EGD) prior to ERCP, rates and times required for successful cannulation into the pancreatobiliary ducts, incidence of post-procedure hyperamylasemia, cardiovascular parameters during the procedure, the dose of a sedative drug, and successful rates of endoscopic naso-biliary drainage (ENBD). RESULTS: Screening gastrointestinal observations were easily performed by the forward-viewing scope and thus no prior EGD was required in the n-ERCP group. There was no significant difference in the rates or times for cannulation, or incidence of hyperamylasemia between the groups. However, the cannulation was relatively difficult in n-ERCP when the scope appeared U-shape under fluoroscopy. Increments of blood pressure and the amount of a sedative drug were significantly lower in the n-ERCP group. ENBD was successfully performed succeeding to the n-ERCP in which mouth-to-nose transfer of the drainage tube was not required. CONCLUSION: n-ERCP is likely a well-tolerable methodwith less cardiovascular stress and no need of prior EGD or mouth-to-nose transfer of the ENBD tube. However, a deliberate application is needed since its performance is difficult in some cases and is not feasible for some endoscopic treatments such as stenting.

Septoplasty and Decongestant Improve Distribution of Nasal Spray

This study prospectively examined the intranasal distribution of nasal spray after nasal septal correction and decongestant administration. A cohort of 20 patients was assessed for the distribution of nasal spray before and after nasal septum surgery. Sprays were dyed and administered one puff per nostril when patients hold their head up in an upright position. Before and after decongestant admini-stration, the intranasal distribution was semi-quantitatively determined by nasal endoscopy. The results showed that the dyed drug was preferentially sprayed onto the nasal vestibule, the head of the inferior turbinate, the anterior part of septum and nasal floor. As far as the anterior-inferior segment of the nasal cavity was concerned, the distribution was found to be influenced neither by the decongestant nor by the surgery （P〉0.05）. However, both the decongestant and surgery expanded the distribution to the anatomical structures in the superior and posterior nasal cavity such as olfactory fissure, middle turbinate head and middle nasal meatus. No distribution was observed in the sphenoethmoidal recess, posterior septum, tail of inferior turbinate and nasopharynx. It was concluded that nasal septum surgery and decongestant administration significantly improves nasal spray distribution in the nasal cavity.

Anatomical variation of the posterior septal artery leads to refractory epistaxis

Purpose:To report a rare variant of the posterior septal artery(PSA),which supplies blood to the posterior mucosa of the contralateral nasal septum.Case report:A 31-year-old female patient underwent suture removal 14 days after septoplasty and developed left-sided epistaxis 6 h after suture removal.To safely and effectively relieve the patient from epistaxis,the cauterization of the left PSA was performed under general anesthesia.However,24 h after the first surgical hemostasis,the patient experienced epistaxis again in the right nasal cavity.We have reviewed the patient's sinus computed tomography again and found a rare variant of PSA,which is the right-sided PSA passing through a bony canal in the left-sided nasal septum.Discussion:The variant of PSA well explained the failure of the first hemostatic surgery.Therefore,we again performed a cauterization of the right-sided PSA,after which the patient recovered and no further epistaxis occurred.Conclusion:When cauterization of PSA is used to manage posterior epistaxis,it is necessary to pay attention to the possible variation in PSA.